AB1371 CENTRAL SENSITIZATION AS A PREDICTOR OF FUNCTIONAL DISABILITY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: V. Bombela, I. Shapoval, M. Stanislavchuk
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis (RA) is a common systemic inflammatory autoimmune disease. Patients with rheumatoid arthritis suffer from chronic pain, restricted function and reduction of daily activities [1]. Recent evidence reveals that central sensitization (CS) is associated with the development and maintenance of chronic pain. [2]. <h3>Objectives</h3> The aim of this study was to determine the functional status of RA patients in the presence of CS. <h3>Methods</h3> The study involved patients diagnosed with RA according to the ACR/EULAR criteria (2010). The presence of the CS phenomenon was established according to the Central Sensitization Inventory (CSI) (Mayer, T. G. Et al., 2012). The Health Assessment Questionnaire-Disability Index (HAQ-DI) was used to assess the functional status of patients. RA activity was determined by DAS-28, SDAI, CDAI. Pain intensity was assessed by Visual Analog Scale (VAS). Statistical analysis was performed using MS Excel and SPSS22 software (©SPSS Inc.). Odds ratios (OR) and their corresponding 95% confidence interval (CI) were calculated. A descriptive analysis of the variables was carried out using mean and standard deviation (M±SD). <h3>Results</h3> A total of 168 RA patients (female 78%) were included. The median age of patients was 52.7±14.1 years, and the median duration of disease was 8.7±7.9 years. The examined patients showed mainly moderate and high activity of the disease (DAS-28 – 4.9±0.9; SDAI – 34,9±9,6; CDAI – 32,0±9,3). The presence of central sensitization (CSI≥40) was revealed in 59 (35%) of patients. The group of patients with CS had greater functional impairment compared to patients without CS: HAQ - 1.9±0.7 versus 1.0±0.6 (p&lt;0.05). Also, patients with CS reported a higher intensity of pain (VAS pain - 7.8±1.2 versus 6.4±1.4; p&lt;0.05). Mild functional disability (HAQ-DI value up to 1) was observed in 41% of patients with RA, moderate (HAQ-DI from 1 to 2) – in 38%, severe (HAQ-DI more than 2) – in 21%. The group of RA patients with CS had significant differences from the group without CS regarding HAQ-DI (Table 1.). Finally, the strong correlation was determined between CSI and HAQ-DI (r=0,745; р≤0,01). Significant moderate correlations were also found between CSI and VAS pain (r=0,532; р≤0,01). We found that the presence of CS in patients with RA was associated with an increased risk of functional disability. Odds ratios are used to identify the risk of functional disorders in patients with CS. RA patients with CSI score ≥ 40 had an odds ratio of 6,97 [95% CI: 3,02 – 16,1] (p &lt; 0.0001) for moderate functional disability and 21,3 [95% CI: 8,07 – 56,4] (p&lt; 0.0001) for severe functional disability. <h3>Conclusion</h3> Central sensitization is common in RA patients. The phenomenon of central sensitization is associated with high level of functional disability of patients with RA and severity of pain. The phenomenon of central sensitization should be considered as a predictor of functional disability. <h3>References</h3> [1]Martinec, R., Pinjatela, R., &amp; Balen, D. (2019). QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS - A PRELIMINARY STUDY. Acta clinica Croatica, 58(1), 157–166. https://doi.org/10.20471/acc.2019.58.01.20 [2]Ji, R. R., Nackley, A., Huh, Y., Terrando, N., &amp; Maixner, W. (2018). Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. Anesthesiology, 129(2), 343–366.https://doi.org/10.1097/ALN.0000000000002130 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.